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Zambia HIV/AIDS Prevention, Care and Treatment (ZPCT) Partnership Cooperative Agreement No

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Zambia HIV/AIDS Prevention, Care and Treatment (ZPCT) Partnership Cooperative Agreement No Zambia HIV/AIDS Prevention, Care and Treatment (ZPCT) Partnership Cooperative Agreement No. 690-A-00-04-00319-00 Quarterly Report for July 1 – September 30, 2008 Submitted by Family Health International (FHI) October 31, 2008 1. EXECUTIVE SUMMARY The Zambia HIV/AIDS Prevention, Care and Treatment Partnership (ZPCT) works with the Ministry of Health (MOH), the Provincial Health Offices (PHOs), and District Health Management Teams (DHMTs) to strengthen and expand HIV/AIDS related services in five provinces: Central, Copperbelt, Luapula, Northern and North Western. ZPCT supports the Government of the Republic of Zambia (GRZ) goals of reducing prevalence rates and providing antiretroviral therapy (ART) by implementing technical, program and management strategies to initiate, improve and scale-up prevention of mother-to-child transmission (PMTCT), counseling and testing (CT) and clinical care services for people living with HIV/AIDS (PLHA), including ART. This quarter, ZPCT supported implementation of HIV/AIDS services in 220 health facilities in 35 districts in the five target provinces, with 219 of these facilities now reporting results. The health facility in Milenge District in Luapula Province has started services but is not yet reporting. Key activities and achievements for this reporting period include: CT services are ongoing in 218 out of 219 reporting health facilities, with 40,859 individuals receiving CT services in these facilities. PMTCT services were provided in 209 ZPCT supported facilities. 34,783 women were provided with PMTCT services (including CT), and 4254 were provided with a complete course of ARV prophylaxis. Ongoing technical assistance was provided to expand and improve clinical palliative care services in all targeted health facilities. 83,708 individuals received palliative care in all 219 reporting ZPCT supported health facilities during this quarter. ART services were available in 34 districts supported by ZPCT. It is still to be determined if the site in Milenge District will have the capacity to provide ART services in the future. This quarter a total of 6137 new clients (including 447 children) were initiated on antiretroviral therapy through 96 (including 50 outreach sites) out of the total 101 planned ART centers. Of the 96 ART sites, 90 report independently and 6 sites report through the bigger facilities. By the end of this reporting period 62,128 individuals were receiving antiretroviral therapy at ZPCT-supported sites and of these, 4227 were children. The following training courses were conducted this quarter: 61 HCWs and 57 community volunteers were trained in basic CT through three, two-week courses. 28 HCWs already trained in basic CT, were trained in child counseling. 30 community volunteers already trained in basic CT were trained in child counseling through two, one- week courses. 20 HCWs were trained in counseling supervision through a two-week course. 43 HCWs were trained in three, two-week courses in provision of PMTCT services. 20 community volunteers were trained in provision of PMTCT services through a one-week course. 101 HCWs were trained in pediatric ART and opportunistic infection (OI) management through three, one-week courses. 47 pharmacy and 16 laboratory staff were trained in commodity management. 174 HCWs were trained in dry blood spot (DBS) collection, storage and transport. 36 M&E staff and data entry clerks were trained in SmartCare software use. In addition, 46 already trained practicing PMTCT HCWs were retrained and updated in a PMTCT refresher course. QA/QI tools have been adapted for use in ZPCT-supported sites and are administered on a quarterly basis to assess, monitor and improve the quality of HIV services. The tools are used to assess the extent to which services are consistent with public health policy and guidelines for the treatment and prevention of HIV disease and related opportunistic infections. Data from implementation of the tools are being entered and analyzed using the CSPro software package. The districts across the five provinces that were identified for graduation by September 30, 2008 have not been graduated. ZPCT and MOH have been working together to monitor QA/QI tools and offer guidance to facility staff on how best they can improve and provide services of good quality. However, graduation plans have continued for seven districts to be graduated by December 31 2008. District-wide referral networks are fully functional in 20 districts and are in development in 14 additional districts. Initiation of referral network activities is planned in all ZPCT-supported districts during this workplan period. ZPCT has identified and worked with 18 community groups to implement community purchase orders to enable the groups to conduct mobilization activities in communities surrounding ZPCT-supported facilities. Community mobilization activities are underway in all five ZPCT-supported provinces. ZPCT staff members continue to provide assistance and leadership on technical and programmatic issues in all key areas at the central level. ZPCT actively participates on eight national technical working groups, as well as several ad-hoc implementation groups. Results for the quarter are summarized in the following table: Services in Health Facilities Receiving ZPCT Support Achievements (May 1, 2005 to September 30, 2008) Workplan Cumulative Indicator Quarterly Achievements Achieve (1 Oct 07 to LOP (1 Jul 08 to 30 Sep 08) ments 30 Sep 08) Percent Achievement (1 Oct Achievement s 07 to 30 (1 May 05 to TARGET FEMALE MALE TOTAL Sep 08) 30 Sep 08) CT Service outlets providing CT 216 218 Persons trained in CT 680 198 614 90% 1,606 Persons receive CT 54,000 21,039 19,820 40,859 152,688 283% 315,121 services PMTCT Service outlets providing 199 209 PMTCT Persons trained in PMTCT 400 111 480 120% 920 Pregnant women provided with PMTCT services, 84,000 34,783 34,783 119,004 142% 236,566 including CT Pregnant women provided with a complete course of 15,750 4,254 4,254 12,630 80% 23,310 ART prophylaxis Basic Health Care and Support Service outlets providing clinical palliative care 216 219 services Service outlets providing general HIV-related 216 219 palliative care Persons provided with OI management and/or 66,690 48,736 34,972 83,708 87,771 132% 92,457 prophylaxis ZPCT Quarterly Report (July 1 – September 30, 2008) 2 Services in Health Facilities Receiving ZPCT Support Achievements (May 1, 2005 to September 30, 2008) Workplan Indicator Quarterly Achievements (1 Oct 07 to (1 Jul 08 to 30 Sep 08) 30 Sep 08) Persons provided with general HIV-related 66,690 48,736 34,972 83,708 87,771 132% 92,457 palliative care Persons trained to provide 200 222 528 264% 1,555 general HIV- related care Treatment Service outlets providing 96 90 ART services Health workers trained in 200 222 528 264% 1,555 ART New clients receiving ART 15,600 3,618 2,519 6,137 23,453 150% 63,072 Total clients receiving ART 51,300 37,190 24,938 62,128 62,128 121% 62,128 Pediatric Treatment Health workers trained in 150 101 187 125% 551 pediatric care New pediatric clients 1,560 185 262 447 1,688 108% 4,439 receiving ART Total pediatric clients 5,130 2,082 2,145 4,227 4,227 82% 4,227 receiving ART TB and Care TB infected clients receiving 7,000 665 779 1,444 5,190 74% 11,400 CT services HIV-infected clients attending HIV care/treatment services that 4,300 491 560 1,051 4,261 99% 7,776 are receiving treatment for TB disease (new cases) Laboratory Infrastructure Number of laboratories with capacity to perform 1) HIV 41 81 tests and 2) CD4 tests and/or lymphocyte tests Number of individuals trained in the provision of 60 200 333% 318 lab-related activities Number of tests performed at USG-supported laboratories during the reporting period: 1) HIV 372,254 184,217 671,197 180% 1,249,311 testing, 2) TB diagnostics, 3) syphilis testing, and 4) HIV disease monitoring ZPCT Quarterly Report (July 1 – September 30, 2008) 3 2. INTRODUCTION The Zambia Prevention, Care and Treatment Partnership (ZPCT) works with the Ministry of Health (MOH), the Provincial Health Offices (PHOs), and District Health Management Teams (DHMTs) to strengthen and expand HIV/AIDS related services in five provinces: Central, Copperbelt, Luapula, Northern and North Western. ZPCT supports the Government of the Republic of Zambia (GRZ) goals of reducing prevalence rates and providing antiretroviral treatment (ART), by implementing program and management strategies to initiate, improve and scale up prevention of mother-to-child transmission (PMTCT), counseling and testing (CT) and clinical care services for people living with HIV/AIDS (PLHA), including ART programs in all ZPCT-supported districts in these five provinces. ZPCT collaborates with the PHOs and DHMTs to strengthen service delivery at public sector facilities and to strengthen networks for referral between these and other public sector health services and communities. ZPCT also collaborates actively with other donor agencies and partner organizations to build on, rather than duplicate, HIV/AIDS programming. ZPCT provides support at national, provincial, district and community levels utilizing health clinics, hospitals and community service delivery programs. At the national level, the program offers technical assistance and coordination to the MOH and the National AIDS Council (NAC), as requested. At the provincial level, the program supports the MOH through technical assistance and coordination in five provinces, and at the district level ZPCT assists the DHMTs and selected health facilities to provide, improve, and expand HIV/AIDS services. At the community level activities include demand creation for services and strengthening linkages between facilities and communities. ZPCT is flexible enough to respond to requests from the MOH as needs arise. Furthermore, all activities and related monitoring and evaluation processes and indicators are designed to meet USAID and the U.S.
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